The 10% Solution For A Healthy Life, Chapter 7: How to Exercise

March 6, 2002

Aerobic versus Anaerobic

In addition to a healthy diet, the other important requirement I recall you mentioning is exercise.

Yes, that is the other primary consideration.

If I jog a few times a week, is that good enough?

Jogging is certainly a satisfactory form of exercise. It is not the ideal exercise to start out with, for reasons I will discuss in a moment.

What form of exercise do you recommend?

First, it is important to distinguish between aerobic exercise, which literally means “with oxygen,” and anaerobic exercise, which involves a high-intensity activity that can only be sustained in short bursts. Examples of aerobic exercise are walking, swimming, cycling, rowing, and cross-country skiing. Any aerobic exercise is very beneficial in terms of significantly lowering the risk of cardiovascular disease, cancer, and other diseases, as well as providing immediate benefits in terms of weight loss, reduced hypertension, improved sleep, and better mood. Regular aerobic exercise can also reduce elevated triglyceride levels and can boost the levels of HDL, the good cholesterol.1

Examples of anaerobic exercise include sprinting, forms of calisthenics, weightlifting, basketball, and tennis.

Tennis is not aerobic exercise?

No, not really. There is some cardiac benefit from the significant exertion involved in a sport like tennis, but it is not an optimal form of aerobic exercise. I would consider these types of sports more as supplements to a regular aerobic exercise program, not the primary component of one.

Aerobic exercise is activity which requires movement of the large upper or lower body muscles continuously in a regular rhythm for at least twenty minutes. Aerobic exercise increases your heart rate and your demand for oxygen but is sustainable for an extended period of time. During aerobic exercise, you should be at your training heart rate.

Training heart rate?

Training Heart Rate

The training heart-rate range is between 65 and 85 percent of your maximum heart rate, which you can estimate as 220 less your age.2 So, for example, if you are 40 years of age, your theoretical maximum heart rate is 180, and your training heart-rate range would be between 117 and 153 beats per minute.

How do I determine my heart rate?

The best way is to obtain a sports watch that provides a pulse readout. Then you do not need to stop your exercise to determine your heart rate. Otherwise, you need to briefly interrupt your exercise and count your pulse for fifteen seconds, then multiply this figure by four. It is important to take your pulse as soon as you stop exercising, because your heart rate will slow down immediately. Once you have estimated your heart rate, continue your exercise routine.

So what’s the best form of aerobic exercise?

Walking

The ideal aerobic exercise is walking. It’s simple. Virtually everyone knows how to do it. You can do it most anywhere. You should have little difficulty elevating your heart rate into your training range on a sustained basis. It does not put undue strain on any of your joints. It is an excellent form of low impact aerobic exercise.

Is that all there is to it-you just walk?

There is nothing unusual about the style or technique of walking required. There are, however, some considerations we should discuss in establishing a safe and effective exercise program.

First, you should consult your physician before starting any regular exercise program. Your doctor can advise you on any special considerations with regard to your physical condition and health. This is essential if you have indications of heart disease or other serious illness.

Exercise Stress Test

In addition, the American College of Sports Medicine recommends that certain people undergo an exercise stress test before starting an exercise program as one way of screening for heart disorders, including advanced atherosclerosis.3 They recommend a stress test prior to starting an exercise program if you are (1) age 45 or over, or (2) between 35 and 44 and have at least one risk factor for coronary artery disease (such as an immediate family member who developed coronary artery disease before age 50, if you are obese, if you smoke, have high blood pressure, or a high cholesterol level), or (3) at any age and have cardiovascular disease, lung disease, diabetes, or hyperthyroidism. If you are under 45, appear to be in good health, and do not have any of these risk factors for coronary artery disease, then you do not need this test, according to the American College of Sports Medicine.

What is an exercise stress test?

It is an electrocardiogram (ECG) administered for ten to fifteen minutes while you exercise on a treadmill or stationary bicycle. Your blood pressure and pulse are also continually monitored. The difficulty of the exercise is progressively increased during the test. The test is stopped when you are too tired to continue, or if any symptoms are noted, such as an abnormally high blood pressure reading, abnormal pulse rate, shortness of breath, chest pain or other discomfort, or an abnormality in the ECG. There is some risk in a stress test, although this is minimal if administered properly by a trained health professional.

The test is far from perfect. About 10 to 20 percent of stress tests give false positives (incorrectly indicating a heart or artery abnormality) and 20 percent to 40 percent yield false negatives. Thus, the exercise stress test will not capture all instances of artery blockage, and any positive indications that it does provide need to be confirmed by further medical tests. Nonetheless, it can be a useful screening procedure that your doctor or fitness instructor may request you undergo before starting an exercise program.

All right, let’s say I’m ready to go. Now what?

The next step is to start. Begin slowly. The objective is to exercise on a regular basis, to build this activity into a predictable routine.

Endurance and the ability to perform more quickly and for longer periods of time will come naturally as your fitness improves.

It is important not to overdo it. You should feel like you are exerting yourself, but if you feel pain in your legs (shin splints, for example), then slow down and rest. If you ever feel pain in your chest, then stop immediately and consult your doctor, because you may be experiencing angina pain indicative of advanced atherosclerosis. (If the pain persists, you could be having a heart attack.)

It is also important to have the right walking shoes. Do not use ordinary sneakers or even running shoes. Obtain a good-quality pair of shoes designed specifically for walking.

How much do I need to do?

Benefits

The results of an 8-year study reported in 1989 in the Journal of the American Medical Association are instructive in answering this question.4 The study divided the 13,344 participants into 5 fitness categories. Individuals in category 1 were sedentary and had no regular exercise program. Individuals in categories 2 and 3 were of medium fitness, which was achieved by walking 30 to 60 minutes per day, 4 to 5 times per week. Individuals in categories 4 and 5 were of high fitness and walked or ran 20 to 30 miles per week or more.

The results were unexpectedly dramatic, and there were significant gains between low and medium fitness, and again between medium and high fitness. The most significant gains were between low and medium fitness, indicating that even moderate regular exercise is of immense benefit. Overall death rates for the medium fitness group were 60 percent less than those of the low-fitness group. Death from cardiovascular disease for men was down by more than two-thirds. There was further benefit for both men and women in the high-fitness category, particularly with regard to cardiovascular disease.

Amount of Exercise

I would recommend the equivalent of walking 3 miles per day or more, 5 or more days per week, although even 4 days per week of regular aerobic exercise is of significant benefit. Once you gain some experience and fitness, this will require about 45 to 50 minutes for each session. Again, it is important to build up to these levels. If you are very out of shape, even walking l mile may be strenuous. So build up gradually, doing a bit more each day. Making a real and permanent commitment to a regular and predictable program is the most important step you can take.

So I just walk, building up to 15 or more miles per week.

The Five Phases of Exercise

It is a little more complicated than that. You should start out with a few minutes of stretching, which will help to reduce injuries, improve coordination and range of motion, and help to relax the body. The most important targets of stretching are the hamstrings, lower back, quadriceps, shins, calves, and Achilles tendons.

The second phase is warm-up, which involves walking at an easy pace, about 3 miles per hour, for a few minutes. This allows you to build momentum, thereby gradually reducing the stress on your muscles and on your heart.

The third phase, which should be the bulk of your exercise routine, is the aerobic phase in which you exercise sufficiently rigorously to bring your heart rate into your training range. This should last at least 20 minutes to obtain a training effect on your heart. In order to cover at least 15 miles per week (once you are sufficiently fit to do this), you will probably want to walk in your training range for 30 to 40 minutes each session. In general, you will need to walk at least 4 miles per hour in order to achieve your training heart rate range.

Following the aerobic phase is the fourth phase, cool-down, which is similar to warm-up. This allows your heart rate to return to normal gradually and prevents a pooling of blood in your legs and feet. Then the fifth and final phase is another several minutes of stretching to maintain limber joints, muscles, and tendons.

If I have difficulty getting into my training heart rate range by walking, are there any ways to make walking more intense?

Varieties of Low-Impact Aerobic Exercise

Yes, there are a variety of ways. You can vigorously swing your arms, which will increase your heart rate and also boost your calorie consumption by 5 to 10 percent. You can do what is called interval walking, which is alternating several minutes of very brisk striding with several minutes of a more moderate pace. This also increases your heart rate and makes the activity more interesting. You can walk on sand if that is available to you, which can increase the calories expended by as much as 30 percent.

You can walk uphill. At a 10 percent incline, you nearly double your expenditure of calories. Of course, it is only in an Escher drawing that you can walk uphill indefinitely without ever going down. To achieve this in real life, I would suggest using a treadmill. The ultimate in walking uphill is stair climbing. You should be careful, however. Walking up metal or concrete stairs carries a high risk of serious injury. I would suggest one of the stair-climbing machines, which have become quite popular. By walking two steps per second, a 150-pound person can burn more than 1,000 calories per hour.

A very effective way to increase both heart rate and calorie consumption is by carrying hand weights. You should not use hand weights if you have heart disease, hypertension, or back problems of any kind. Use one or two-pound weights and a controlled pattern of arm movements. Do not swing the weights wildly.

TABLE 5: CALORIE EXPENDITURE PER HOUR FROM WALKINGCalories Burned per Hour

The calories burned per hour by walking on a level surface without hand weights.

TABLE 6: CALORIE EXPENDITURE PER HOUR FROM WALKING ON A 5 AND 10 PERCENT INCLINECalories Burned per Hour

The calories burned per hour by walking 3 miles per hour nearly doubles on a 10 percent incline.

Okay, now what about running or jogging? Isn’t that an intense form of walking?

Essentially, yes. Running is definitely aerobic and is more intense than walking. While I would never discourage someone who runs on a regular basis from continuing this excellent form of aerobic activity, I do think it is worthwhile to point out some of the disadvantages to those considering what form of exercise to start with. Jogging or running is, in essence, a series of jumps, each of which conveys a load to your feet and legs equal to three times your weight or more. The force on your feet is even greater, up to 30 times the force of gravity. This sends a shock wave through your body at 200 miles per hour, which is absorbed by your bones and soft tissues. All of this puts cumulative stress on your body, particularly the feet, ankles, lower leg, and knees. Over time, this can cause shin splints, tendonitis, stress fractures, orthopedic difficulties, and other problems. A large fraction of runners develop injuries, some of which can be serious. To some extent, the potential for injury has been ameliorated by the development of well designed running shoes. I strongly recommend that you obtain appropriate footwear designed specifically for running if you wish to consider this form of exercise. It is also desirable to find a relatively soft surface to run on, such as dirt, grass, or a running track, as opposed to concrete. There is no question, however, that you can obtain intense aerobic benefits from running, and it certainly is efficient.

What other forms of exercise do you recommend?

There are a variety of low-impact aerobic exercise activities that are ideal for increasing cardiovascular endurance and strengthening the pulmonary system. Swimming is low impact although it is important to use proper form. One advantage of swimming is that it is easier to move one’s limbs in the water because of the significant reduction in one’s apparent weight. For this reason, swimming and water aerobics (aerobic exercise in the water using a flotation ring) are ideal forms of exercise for anyone, especially the elderly, and others who suffer from muscle or joint infirmities and injuries. Also, swimming is excellent for active people who, due to injury, cannot continue their usual aerobic activity. Because swimming is a non-weight-bearing form of aerobic activity, it is significantly less stressful on the body than other forms of exercise.

Aerobic classes can be ideal, although I would emphasize the low impact variety. A competent instructor will guide you through the appropriate stages of stretching, warm-up, aerobic exercise, and cool down. Aerobic dancing is also enjoyable. Any movement to music can help keep up both momentum and motivation.

Bicycling is both aerobic and low impact if the proper form is used. One disadvantage of bicycling is the rapid change from high intensity to low. Experienced cyclists are able to maintain a fairly even expenditure of energy through appropriate gear changes, although this takes practice. Continuous aerobic exercise is easy to achieve on indoor stationary bikes. When cycling outdoors, be sure to use a safety helmet and try to avoid roads with heavy traffic.

TABLE 7: THE CALORIC VALUE OF DIFFERENT FORMS OF EXERCISE (PER HOUR)

Data from: W. D. McArdle, F. I. Katch, and V. L. Katch, Exercise Physiology: Energy Nutrition and Human Performance 3d ed.(Philadelphia: Lea and Febiger, 1991).

An ideal form of exercise is cross-country skiing. This activity provides a workout for muscle groups in both the upper and lower body. It is vigorous and invigorating, particularly in an attractive setting. The only disadvantage is that it is not always available. Another exercise that uses both the upper and lower body is rowing (in a boat or on a machine). Here again, proper form is essential to avoid lower back injury.

It isn’t always possible to exercise outdoors, given the vagaries of the weather.

That is a very good point. Since it is desirable to exercise almost everyday, depending on the weather is not a good strategy for people in most places in the world. One solution is membership in a health club with appropriate facilities, this has the added benefit of supervision, which can be both instructive and motivational.

It is also very desirable to have some facilities in your home. For many people, this is the most efficient way to make exercise a regular part of their day. Although not inexpensive, the one piece of equipment that I would strongly recommend is a treadmill. If your primary aerobic activity is walking, having your own treadmill is an ideal way to assure a continuous program. Without your own treadmill, maintaining a regular program of walking may be impossible unless the weather in your area is predictably accommodating. Most people find that a treadmill is a much more satisfactory way to exercise at home than a stationary bicycle, which can become tedious.

I’m glad you mentioned tedium, because any of these exercises can become tedious if you do it every day.

I’m not sure I agree with that. If you find the right exercise for you, it can be an enjoyable part of your routine. Walking outside can be a refreshing way to tour your neighborhood.

Assuming your neighborhood is one you want to walk around in.

Yes, that certainly is a consideration. Other ways to avoid tedium include exercising with friends, listening to music, or watching television. Or the exercise period can be a time of reflection, an opportunity to let your thoughts wander. Physical exertion combined with mental relaxation is an ideal combination to reduce stress.

You may also wish to vary your exercise routine-walk one day, bicycle another-as a way of adding interest. What is most important is that you develop an exercise routine that is enjoyable to you and that you can look forward to. Many people report that once you become accustomed to an exercise routine, it feels awful to stop.

Any recommendations on when to exercise?

I would strongly suggest picking a time of day to exercise that can become a normal part of your routine. It is not a good idea to exercise within thirty to forty-five minutes after eating. Therefore, many people find it convenient to exercise right before a meal, in the morning before breakfast, before lunch, or before dinner. It is also not ideal to exercise late at night right before going to sleep, particularly if you have any difficulty sleeping.

How am I supposed to find the time for this? There are so many things that are crucial for me to do: spend time with my family, eat right, exercise, not to mention all the demands of work.

I can’t solve that problem for you. You have to set priorities. But it is important to note that exercise will pay for itself. The dramatic improvements in your energy level, ability to sleep, and sense of well being mean that you are not really “losing” time. It turns out that the busiest and most successful business executives are frequently the most diligent about their exercise routines.

I guess people like that are diligent about everything they do.

Perhaps they are. But the most important thing about exercise is not any of the fine points of technique and form, rather just the fact that you do it on a regular basis.

As they say, no pain, no gain.

Actually, I should point out that exercise should definitely not be painful. There is no harm in breaking a sweat. In fact, it is difficult to achieve one’s training heart-rate range without sweating. But you should avoid pain. Pain is certainly demoralizing, and, depending on the source, can be an indication of injury, angina, or other condition that should not be tolerated. A good test to see if you are overexerting yourself is the talk test. If you are too fatigued to carry on a conversation, then you are working too hard and should slow down.

As with weight loss, it is important to get on the right track and make a commitment to stay on it. Do not be overly anxious about your progress.

So I should not be concerned with the progress of my exercise program?

You should not be overly concerned. But I do recommend that you keep a written record of your progress, because if you keep up the program you cannot help but advance each week in your endurance and fitness. Seeing a record of your progress will be a positive motivation to keep going.

So this is something else I have to keep track of now?

This does not need to be onerous. If you are walking, you can just write down how far you went and how long it took. You can even do this just once a week to see how your capability improves over time.

Sometimes I have to travel. It’s kind of difficult keeping up an exercise routine on the road.

It shouldn’t be. That’s one reason I recommend walking as a mainstay of any exercise program. It is not always possible to find a bicycle or a swimming pool, let alone a facility for cross-country skiing. But walking is usually quite feasible. Also, with the increasing interest in fitness, many hotels provide exercise facilities, and you can make this a criterion in your selection of a place to stay. As for finding time, it just comes down to priorities.

How about if I am not feeling well?

Use common sense. Do not exercise if you are ill, particularly if you have a fever. If you miss a week or more of your exercise routine, then restart your program cautiously once you are well. You lose fitness twice as quickly as you develop it, so do not be discouraged if it takes time to get back to the level of fitness you reached prior to the illness.

Well, I shouldn’t be getting ill if I follow the 10% solution, isn’t that right?

I’m afraid I can’t give you that guarantee. You will certainly dramatically reduce your risk of heart disease, cancer, and other major diseases and strengthen your immune system, which helps in fighting any disease. You are likely to have minor illnesses a lot less frequently by avoiding the poisonous diet that our society consumes and by keeping your body fit. But we cannot say that you are assured of avoiding all illness.

How about calisthenics? Aren’t they good for turning fat into muscle?

First of all, you can’t turn fat into muscle, nor can you firm up fat. You have to lose the fat through a weight-loss program aimed at reduction of body fat. That is achieved by a low-fat diet, calorie control, and exercise. At the same time that you are losing your excess fat, you can develop your muscles through exercise. Calisthenics will firm and tone your muscles, and there is nothing wrong with that. But for cardiovascular fitness as well as for weight loss, you need aerobic exercise, and calisthenics is not aerobic.

Any other tips?

Take advantage of every opportunity to use your body rather than the array of labor-saving devices that surround us. Use the stairs as opposed to the elevator. Walk or bicycle to your destination instead of hopping into the car for short trips. These are not substitutes for your regular exercise routine, but this is a useful attitude to develop.

Anything else?

Yes, a reminder that exercise alone is not sufficient. Exercise will not reduce levels of LDL, the bad cholesterol in your blood. There is a myth that you can eat whatever you want if you just exercise. But the long list of marathon runners who have had sudden and often fatal heart attacks due to advanced atherosclerosis is a clear indication that exercise alone is not an antidote for the devastating effects of a diet high in fat, cholesterol, and sodium.5 The dietary and exercise recommendations of the 10% solution go hand in hand. They work together synergistically. The benefits of applying both principles is greater than the sum of the benefits of either one alone.